Source: Focus Malaysia March 3-9, 2018
Source: Focus Malaysia March 3-9, 2018
Taiwan is considered more advanced in its elderly care services and is said to be facing a social time bomb as its population ages. However for a country such as Malaysia which is still making headway in addressing its ageing populations needs, it was certainly a welcomed sight to know what they have put in place.
A recent visit to Taiwan by Aged Care Group (ACG) offered a good insight into the aged lifestyle as we were introduced to the various living conditions built to cater to this growing demographics – apartments for elderly, a village concept for those who are still active and independent, an integrated service centre, community day care centre as well as privately owned facilities that are equipped with smart technology solutions that provide assistance to daily living for the elderly.
What was evident is the planning and thought process that was put forward in the design development of the places which can be segregated into 2 models “ageing in retirement village or apartment” and “ageing in place”. Taking a closer look into these living conditions – what is evident is that both models have its advantages.
Taiwan’s Elderly Care
1. Ageing in retirement village or apartment model
Ruen Fu New Life Retirement Home and Chang Gung Health & Cultural Village in Taipei. They are both Independent Living Unit (ILU) run by the private sector. Looking into their service offerings, they come with well-equipped facilities and age friendly environment.
Ruen Fu New Life Retirement Home location is just next to Tamkang University in Taipei, which is next to the school district, provides a lively feel where elderly could easily connect with the students. Their activities is held in a hotel-like complex space, where it split into different section such as gym room, mahjong area, reading area, performing stage etc. In term of security, they are providing security access card control system, 24 hours emergency call service, infrared sensing system in room. On health management side, they have 24-hours nurses on standby, providing clinic appointment, health information and health talk.
Chang Gung Health & Cultural Village is located in a more rural and remote area in New Taipei City which comes with a big piece of land. Its unique feature is that the outdoor spaces are accessible and open for residents and non-residents, trails for walks and fields within the plantation as well as engaging with the youngsters – watching them play basketball etc. There are also free classes for the residents to participate – calligraphy, computer, language, dance, drawing etc.
In term of security, residents are connected to the hospital monitoring system. Every building is equipped with nurse station and sphygmomanometer station, let their resident do their own blood pressure checking.
Chang Gung also using security access card control system but the card also functions as a debit card and stores personal health records. For example, the resident can debit all their food expenses by scanning their card, every time the resident wish to perform a blood pressure check also have to scan their card first, so that their health status will be recorded.
Those who reside in the retirement village or apartment are those who financially able as they pay a monthly rental with quite a hefty deposit.
What was noticeable for both the retirement apartment and village are that their staff are very friendly which is shown through the services and care offered. This makes the elderly feel at home with the warmth they feel and you can see that trust within their hearts as they are constantly having a smile on their face.
2. Ageing- in- place model
Ageing-in-place is a concept where an elderly ages within the comfort of their own home.
The Government of Taiwan have been promoting ageing-in-place since 2007 under their “Long Term Care 1.0” plan. After 10 years of implementing it, they are now enhanced into “Long Term Care 2.0”. This plan promotes a community based long-term care system which provides affordable care services to its residents. Government will subsidy the lower income group to access to the services.
Under their “Long Term Care 2.0”, they are expanding their 8 services to 17 services which includes daycare, transportation, home nursing, home (community) rehab, respite care, dementia care, caregiver support group, long term care service centre, small scale multifunction services centre etc.
The senior integrated service centre was built by the Taiwan Kaohsiung City Government to bridge the gap in social inclusion for the elderly. The centre brings together the elderly through leisure activities, learning programmes with daycare facilities and is even catered for those with Dementia. They have different classes and facility where all the active elderly can take part and interact with each other. The day care services not only providing the suitable & proper care for the elderly, but also helping adult children to ease their burden during working hours, while they can still bring parents back to home afterward.
While the senior integrated services centre serves as headquarters, there are also small scale multifunction services centre (satellite community care centres) in different residential areas set up. The function of community care centre is to provide daycare and homecare services within the community. The Kaohsiung City Government is working towards providing comprehensive services to allow ageing-in-place by integrating social activities into the care provision similar to what the retirement villages and apartments specific for the elderly.
It was a welcomed sight to watch the Taiwan elderlies enjoy the activities and services offered by the government. Throughout the whole visit, some of the elderlies also were excited to show us their works or what they learnt from the programmes.
The staffs informed us classes like dancing, calligraphy, ink painting are all hot in demand classes, where elderly need to wait for their turn to learn. Age doesn’t limit the passion of learning for those elderly, and yet they choose to visit services centre rather than just sitting at home – something that we Malaysians take note of.
3. Technology is an important enabler when it comes to ageing.
Imagine our living place is the hardware, the services or activities are the software, and technology is the lubricant that enables the seamless process.
Stipendiary Taiwan is a continuum care centre where daycare, short term stay, home nursing and homecare are embedded into their service offerings. Looking into their diversity of elderly and the care provision, technology plays a critical component where the utilisation of an IOT security smart environment with GPS to track elderly movement in particular spaces. Their wearable devices able to track elderly health status, smart mattress with motion sensor able to prevent elderly from falling down when they get out from bed. They have also progressed into developing their own Smart device solutions to compile and manage the process of homecare & home nursing services through app. It is a system to locate the people who need care and the status of care provider.
Like what we see from the retirement villages or apartments, both are using technology for security purposes, Chang Gung Health & Cultural Village even use the access card as debit card and health status recorder. What can be said that a successful formula in enhancing the quality and provision of care for our elderly would be that technology is the key enabler.
What we can learn from Taiwan
A survey done by ACG in 2015 shows that the top reason for why the elderly chose to stay in a nursing home or care centre is the lack of family support at home and family members not having the relevant caregiving skills to take care of them.
In other words, elderly would like to stay in their home, where they can always spend time with family——the rationale behind it is the Asian value and culture where we wish to look after our parents, and wish to stay with our family members until we passed away.
However, things just don’t turn out the way you want, the level of care that the elderly need might change overnight, which then requires them to need constant health monitoring.
That is also what Taiwan Government trying to achieve through their Long Term Care Plan, where elderly don’t need to leave the confines of their home or community, but a service team will be despatched to visit you.
Taiwan experience show that retirement villages and apartments have all the proper “in house” facilities and services, but the deposit and rental for staying there is definitely higher than staying at home; The costs for ageing- in-place is more affordable, but it can only work when there is a strong homecare and social service team just like the support provided by Kaohsiung City Government.
Another important element that we can learn from Taiwan is their “Human Touch”- how the staff or service team communicate or interact with elderly. This is the most important aspect that we should have whether you are running a community based services centre or retirement village, it is about creating a feeling for elderly that they are chatting, playing or eating with family member, not a stranger.
Ageing- in-place or ageing in a retirement village is about choices and options, they are pros and cons but in term of volume of people who will get immediate benefit, ageing- in-place seems like a model that can bring immediate impact to Malaysians. By embracing technology—— developing a homecare system or app to enable the whole process, could make ageing- in-place even better.
Although Malaysia is moving toward to ageing nation, but our facilities and services requires a lot of improvement. As sources are limited and to ensure that we are well prepared as our nation ages, bringing together the public and private parties in a collaborative effort would be something that really needs to be driven forward. As the saying goes- “One hand alone can’t clap, it takes two to make a difference”. Let’s work towards a better tomorrow not only for ourselves but also for our generations to come.
Flip open the newspaper and you will likely find an article related to seniors – the care required, their living condition, struggles, healthcare, etc. Recently, The Star published an article on the need for laws that protect the rights of seniors in Malaysia as various social dilemmas – such as abandonment – have arisen from the lack of it. These social tensions are signs that our aged care system is being stretched by the growing needs of an ageing population.
Malaysia need laws that not only covers senior citizen’s rights, but also define the roles of stakeholders; from the state, the community, family members and service providers – such as long term residential and care homes, day care centres, housing developments, transportation, commercial outlets, etc. – alike. This requires all parties to be on the same page. It is clear our aged care system cannot sustain our needs. Hence, we must understand current aged care trends to determine what types of care services are needed and how to sustainably deliver it.
Trends & Payment Modes
As we age, the possibility of needing some form of long-term care is evident. Beyond the initial stages of care during hospitalisation, long-term care (also known as LTC) comprises a variety of services with the purpose of meeting both medical and non-medical needs of people with chronic illnesses/disabilities and are unable to care for themselves for long periods of time. It can be provided at home, in the community and in assisted living facilities like nursing homes and care centres.
As far as trends go, there is an increasing need for expertise by professionals to address multiple chronic conditions often associated with seniors in the provision of long-term care. Likewise, the need for non-medical care such as Activities of Daily Living (or ADL) – which involves activities such as feeding, bathing, dressing and handling of ‘nature call’ issues – is increasing. However, unlike medical care, funding options for non-medical care is not easily available.
In Malaysia, the care that is needed and provided to seniors are delivered through government welfare homes, private nursing homes & day-care centres, voluntary aged-care centres, or by families at home. Naturally, this mix of delivery channels and agents would result in each option having very different funding bases.
The finance options available to seniors to pay for long-term care services include: the individual’s own savings, their Employees Provident Fund (EPF) accounts, pension scheme, investments, government welfare and other sources of income like investments and business income. However, unlike developed countries such as Japan, there are no risk-pooling arrangements such as social insurance and tax-based funding for long-term care available in Malaysia.
As can be inferred by the nature of our available options (apart from government welfare), Malaysians generally make out-of-pocket payments to finance their own or a family member’s long-term care needs.
As a result of financing their care support, there is a noticeable trend in the growth of self-directed (or consumer-directed) services. Despite the obvious challenges inherent with an aged care system largely reliant on individuals making self-funded payments for care, the results of self-directed services grants seniors greater independence and control over their lifestyle choices.
However, while the trend of these self-directed purchases of services are believed to improve the quality of care while simultaneously being cost effective due to the supply and demand economic model, we need to work out the kinks and flaws in Malaysia’s aged care infrastructure – namely our payment options – to fully capitalise on its strengths and minus the weaknesses. The specific challenges inherent in our payment options lie in these four areas:
1. Lack of Representation When Impaired
The benefits of the self-directed payment approach are appealing. It not only provides consumers with greater lifestyle choices and higher accountability in the services supplied, it’s also attractive to some governments due to its links with market-oriented mechanisms.
However, the drawbacks lie in monitoring and purchasing of services, which hinges on the purchaser’s health and mental condition. If the purchaser is frail or mentally impaired and without family support, their bargaining power relative to service providers is compromised and may risk exploitation by service providers as well. Furthermore, this approach does not offer a guaranteed care provision “until end of life” for all individuals.
2. Education & Employment
One of the main factors affecting our Malaysian seniors’ financial resources is due to the low educational attainment, which impacts their ability to save for old age. It is compounded further when their chances of improving their economic conditions become increasingly limited as they get older and their capacity to work diminishes.
3. Insufficient Savings & The Sandwich Generation
Constant reports from the EPF stated that Malaysians aren’t saving enough for retirement and old age. When funds from their EPF accounts are exhausted, family members often become the main welfare provider – both financially and in providing social support to the senior.
Furthermore, the “Sandwich Generation” trend are also linked with the senior’s inability to accumulate sufficient savings or for the savings to last throughout retirement. Due to changes in family size and economic conditions such as higher cost of living (e.g. high prices for housing), Adult children find themselves taking care of their aged parents expenses in addition to raising their own children. In some cases, the senior parents also providing financial support to adult children.
4. Too New To Collect Results
In 2012, the Malaysian government introduced the Private Retirement Scheme (PRS). The objective was to improve living standards for retired Malaysians through additional fund savings. However, as the PRS was implemented six years ago, the effectiveness of this initiative is still too early to assess as an avenue of long-term care funding for elderly Malaysians.
What Lies Beneath
Regardless of overcoming the abovementioned challenges, developing better payment options would be mooted if the practice of inappropriate allocation of care is not addressed. As a senior’s care needs intensifies as they age and medical inflation rises, the appropriate placement of seniors is all the more paramount. When they are accorded the right level of care – which meets the minimum standards required by the regulators – the senior’s financial resources are more likely to be utilised optimally.
This is especially important in managing long-term care costs as it can be difficult to measure due to the nature of the care required by the senior. When costs are not properly managed, the quality of long-term care services may be significantly affected. Additionally, inefficient delivery of long-term care may also affect the price of services delivered and this could lead to the senior being unable to pay for the care needed on a sustained basis.
In Taiwan for example, it is found that care at home was cost-effective for people with “medium” physical disability, but became expensive for people with higher levels of disability when compared with nursing home care. Such findings raise issues about the relationship link between needs and actual care received.
Ultimately, the changing climate in Malaysia’s ageing needs dictates that our current infrastructure and practices cannot remain at status quo. New payment options for long-term care (or at the very least, a revision of our old ones) and the environment required for these options to flourish needs to be investigated, deliberated and developed.
Much of the efforts by the Malaysian government to implement avenues for retirement, and by extension aged care, are still relatively new and time will tell if these efforts are effective. However, for the foreseeable future the challenges that lies ahead for Malaysia is firstly a pension reform. We need a review of social protection for the purpose of preventing poverty for our ageing population and develop a plan that provides adequate benefits that includes long-term care.
This is because a full replacement of income for retirement cannot be obtained purely from one single source or scheme but different tiers must be incorporated so that full replacement can be achieved.
Secondly, we need a total structural adjustment of the economy to cater to Malaysia’s ageing needs. As industry players, we need to ensure that future developments in ageing policies should include the provision of better care services with more uptake to enable cost-effectiveness.
Finally, greater efforts to evenly distribute aged care services and facilities between cities and country areas to ensure no one is neglected.
Source: Smart Investor, July 2017
Written By: Aged Care Group
A conversation with Woods Bagot Health & Science Sector Leader, Vic Benakovic and Health & Science Sector Specialist, Nikki Beckman discussing the design shift in Aged Care planning to a more holistic Multigenerational Living model.
The growth of Malaysia’s ageing population has spurred an increasing urgency to address the needs and challenges of the aged care industry. With one of the most apparent challenges facing the aged care industry being the lack of aged friendly infrastructure, it is obvious that Malaysia is in need for an aged-friendly environment upgrade. We have yet to see designs in shopping centres, parks, walking paths, buildings and houses being developed in a manner that are friendly to people of all types of circumstance and not just to those in normal physical/mental condition.
Creating an aged-friendly environment is parallel to creating a happy ageing lifestyle for not only the elderly, but also ourselves and future generations to come. While Malaysia is named one of the top 10 places for retirement in early 2016 by International Living, citing our healthcare industry as being medically on par with developed countries while being more affordable, there is still a much needed improvement for both our infrastructure to be aged-friendly supportive and to instil a positive outlook towards ageing.
Enter Woods Bagot. Since being established in 1869, Woods Bagot is a global architectural and consulting practice with almost 150 years of experience specialising in design and planning for a wide variety of sectors from aviation and transport to education, sport, lifestyle and workplace environments to science & health. Having been awarded the International Practice of the Year by Architects Journal and the International Architecture of the Year by the Australian Institute of Architects, they were named the world’s 6th largest architecture firm in Building Design magazine’s World Architecture 100 list.
By tapping into their vast experience in architecture, Aged Care Group together with Woods Bagot intends to address the lack of an aged friendly infrastructure in Malaysia and innovate the perception of ageing. The Woods Bagot innovative approach to addressing both present and future needs of our Multigenerational Communities is led by Vic Benakovic (Health & Science Sector Leader) and Nikki Beckman (Health & Science Sector Specialist). “The negative perception of ageing, both in the quality of life and quality of facilities has been ignored for far too long,” says Vic Benakovic. In design and planning, Vic stated that Woods Bagot strove to ensure all their designs were developed for ‘multi-generational living’. The end result being developed facilities that are enticing and suitable for occupation for residents of all ages and needs.
Behind the Design
As a business, the core of Woods Bagot’s approach to design is the focus on the element of ‘human-centeredness’ as each assignment undertaken is planned, designed and developed in a manner that is marked with humanistic values. To create designs devoted to human welfare in mind, Beckman explains Woods Bagot uses their unique process called ‘Super Space’, which combines computational analysis and design that predicts human behaviour and maps social & physical trends within organisations and cities. By using ‘Super Space’, Woods Bagot is able to understand and unlock the possibilities of planning with an understanding on how occupants use space and available amenities within that space.
The essence of good design and planning is in the designs’ ability to have understood the ‘needs’ of the occupants and is able to cater to their ‘wants’ while evaluating and adopting emerging trends. “In planning multi-generational environments, this process (Super Space) will assist in creating human-centred environments as the data taken into consideration has to do with how individuals prefer to occupy space as well as acknowledging ‘habits’ and ‘comfort’ zones” said Beckman.
Creating an age-friendly environment requires time with careful thought and considerations for living not only in the present, but also well into the future and not simply a patch work of fixing-as-it-comes approach. In order to have a multi-generational infrastructure compatible with all ages, it is not just merely installing wheelchair-and-walker-friendly walk-ways, it requires 3 practical aspects that are critically important in design consideration to balance a more residential like appearance while mitigating risk of injury. The 3 aspects being:
Benakovic stated that facilities have to capture an overall ‘wellness’ approach to create desirable environments incorporating key considerations such as noise control, air quality, thermal comfort, privacy, autonomy, natural light, views & connection with nature, colour texture that are family friendly, safe and secure.
‘Want’ or ‘Need’?
Thus far, the negative perception associated with senior living has in large to do with the traditional pathway senior citizens have taken to move into an aged care facility and the availability of quality and supportive facilities. Currently with the lack of enforcement in ensuring the operation of care centres adhere to required standards, the quality of nursing homes naturally varies, giving rise to less than ideal experiences that increase negativity towards senior living.
Furthermore, the decision to move from the home has often occurred only when remaining at home with immediate family or living independently has become difficult and unsafe. Entering a new home environment under such a stressful state then, produces greater resistance to the move and towards the facility’s offerings. Additionally, moving much later in life limits the option of participating in the available activities of the facilities. The outcome often leads to a ‘negative’ ageing experience for both the individual and their families, giving rise to feelings of being alienated, loneliness and depression.
In addressing this issue, Beckman states that the multi-generational living model has the ability to counter this perception, transforming it into a positive ageing experience both for the individual, their families, and the industry whole. “The new model promotes and entices the individual to take up residency much earlier in life than is needed, reducing the emphasis on critical care“ said Beckman. By creating a shift from ‘needing’ to move to ‘choosing’ to move, the model assists in creating happier residents with a greater will to live, improved quality of life and with the appropriate support to live longer.
Physical Form of the Infrastructure
As people have a tendency towards having a preference for the familiar, Benakovic stated that the physical form of the infrastructure itself should respond to the cultural and social characteristics of its location, occupants, climatic conditions and incorporate the local forms and materials which are familiar to the occupants.
When developing the facilities, the interiors should generate a calming and comfortable effect and scaled appropriately to create interactive and private zones. At the same time, the building’s surrounding grounds should be safe and accessible for all ages. Additionally, the most important influencing factor is to consider how its form will ultimately affect the occupants both from a physical and psychological response.
When creating a design to be strong and lasting, it is important to have an understanding and appreciation of the local lifestyles & history and to avoid making the mistakes of ‘importing’ the ‘latest & greatest’ from other countries without understanding why they have been successful or considering how they will fit into the local requirement.
“Functional planning should be pragmatic, intuitive and based on best practice, but these fundamentals need to be tailored to suit each specific project undertaken. This ensures the best thinking and approach is balanced against cultural, contextual, financial, and operational requirements to achieve the most comprehensive and relevant design solution” said Benakovic.
Additionally, a multi-generational living infrastructure should be designed in an appropriately environmental friendly manner. The conservation and re-use of energy, water and other natural resources should be part of the initial designing stages and implemented where appropriate. This in turn has the beneficial outcome of providing a sustainable cycle which provides occupants with opportunities for empowerment, engagement and ownership of their new home. It also provides a rewarding social activity for the residents by having them become actively involved in the conservation process.
Laying Down Foundations
Malaysia is fast becoming an ageing population facing a myriad of social, cultural, demographic, financial shifts, along with changing lifestyles. Therefore, it is of primary importance that multi-generational living facilities need to be adaptable – not only in their delivery of care and provision of support in terms of both mental and emotional aspects – but also within the provision of amenities, engagement with community and lifestyle led offerings.
According to Benakovic, the most successful model is one that understands its’ occupants ‘needs and wants’ from a holistic approach and is flexible enough to recognise the subtle differences that all individuals have. Ultimately, it all comes back to offering a choice of activities and choice in support. This is crucial in allowing residents to retain a high level of independence in making decisions and having choices not only where they want to live but also how they want to live.